Maternal and Child Welfare in England and Wales Between the Wars: A Comparative Regional Study Elizabeth Peretz Ph. D 1992 BEST COPY AVAILABLE Variable print quality MATERNAL AND CHILD WELFARE IN ENGLAND AND WALES BETWEEN THE WARS: A COMPARATIVE REGIONAL STUDY ELIZABETH PERETZ Ph. D. (submitted in partial fulfilment of the requirements for this degree) November 1992 I Ree, Middlesex University Dr Charles Webster, University of Oxford: - Wellcome Unit for the History of Medicine 1985-88. All Souls College 1988- Ah!; Lrmrt Maternal and Child Welfare in England and Wales Between the Wars: A Comparative Regional Study, Elizabeth Peretz. This study explores the factors which shaped the local maternal and child welfare services of the inter-war period. It draws on research from local authority minute books, local newspapers, and from mothers themselves. It shows the strong influences exerted by the complex interplay of geographical, economic, political and cultural factors in determining the shape of services in the four very different localities studied here. The services were very different in the different localities, in two of the four areas expensive for the mothers, offering little practical medical or material help, and relying heavily on voluntary effort to meet government targets of every scheme being as self-sufficient as possible. Although it is shown that those indices of maternal and infant health, the infant and maternal mortality rates, fell in all four areas studied, the precise connection between educating the mothers and better perinatal and infant health remains to be established. Acknowledgments This thesis could not have been written without the help and supervision of Dr Charles Webster and the encouragement of Jonathan Ree. I am also indebted to Dr Irvine Loudon, Dr Anne Laurence and Sean Loudon for their help at various stages, and to Dr Stephen Brown, Dr Lara Marks, Dr Hilary Marland, Dr Anne Marie Rafferty, lack Walton, and Ruth Walton for their support. Much of the thesis has already been published as essays and articles. These have formed the basis of the following chapters: Chapter One is based on Elizabeth Peretz, 'Regional variation in maternal and child welfare Between the wars: Merthyr Tydfil, Oxfordshire and Tottenham' in Philip Swan and David Foster, (eds), Essays in Regional and Local History, Beverley, 1992. Chapter Two is an expanded version of Elizabeth Peretz, 'Infant welfare in inter-war Oxford', in Richard Whiting, (ed. ), Oxford and its People, Manchester, forthcoming. Chapter Three is an expanded version of Elizabeth Peretz, 'A maternity service for England and Wales: Local Authority maternity care in the inter- war period in Oxfordshire and Tottenham', in So Garcia, Robert Kilpatrick and Martin Richards, (eds), The Politics of Maternity Care, Oxford, 1990. Chapter Five borrows half of its material from Elizabeth Peretz, 'The professionalisation of childcare', Oral History Journal, Vol 17, No 1, Spring 1989. Chapter Six is an amended version of Elizabeth Peretz, 'The costs of modern 'in Valerie Fildes, motherhood to low income families in inter-war Britainl, Lara Marks and Hilary Marland, (eds), Women and Children-FirstL International Maternal and Infant Welfare. 1870-1945, London, 1992. The Tables in Chapters One and Six are reproduced from the original versions above. Contp. nts Introduction Chapter One Variation in maternity and child welfare between the wars: A comparison of Merthyr Tydfil, Oxfordshire, Tottenham and Oxford Chapter Two 35 Infant welfare Chapter Three 70 Maternity arrangements Chapter Four 94 Nurture or social engineering? Provision outside the home for the 2-5 year old in the inter-war period Chapter Five 106 The influence of professional groups and individuals on the shape of inter-war maternity and child welfare services Chapter Six 127 The costs of modern motherhood to low income families in inter-war Britain Chapter Seven 154 The mothers themselves Appendix I 1 Appendix 29 ABBREVIATIONS Lewis, Politics of Motherhood - Jane Lewis, The Politics of Motherhood, London, 1980 MCW Committee Minutes - Maternity and Child Welfare Committee Minutes MOH A/R - Medical Officer of Health Annual Report NSPCC - National Society for the Prevention of Cruelty to Children Our Towns - Our Towns: A Close-Up., Women's Group on Public Welfare, with a preface by Margaret Bondfield, London, 1943, 4th impression 1943 PH Committee Minutes - Public Health Committee Minutes PRO - Public Record Office Social Services in Oxford -A Survey of the Social Services in the Oxford District, Barnett House Survey Committee, 2 Vols, London, 1938,1940 INTRODUCTION The history of public health and social welfare in the inter-war years in England and Wales is the history of public campaigns and enabling legislation. Trends and patterns were shaped by the interplay of national and local forces, leading to what Roger Lee terms the 'uneven zenith' of the power of local authorities in the 1930s (1). The Maternity and Child Welfare Act of 1918, with which this thesis starts, was a permissive piece of legislation. It was mainly a list of items which could attract government grants of up to 50%. The only statutory responsibility the Act gave to local authorities concerned committee duties and membership; one committee had to take on maternal and child welfare matters as a discrete set of responsibilities, and that committee had to contain at least two women as co-opted or elected members. The three main areas of maternity and child welfare I discuss below are provision for infants and babies, particularly infant welfare centres; provision for mothers, from birth control to post-natal care; and provision for two to five year olds in nurseries or elsewhere. I look separately at the staff who ran or funded these services, and the mothers who used them, with particular reference to costs and charging. The Ministry and its Maternity and Child Welfare Department laid down some prescriptions for regarding the shape of maternity services, and services infants. In these areas of provision there are some local differences but also significant similarities. There was little attempt from Whitehall either to promote or standardise provision for two to five year olds, which makes local initiatives particularly interesting to study. I have chosen the localities for their contrasts, and also for the availability of their records. Oxford City is a mine of information, almost obsessive in its record keeping on the voluntary, the personal, and the local authority side. Also, having an unusually stable middle-class population, there were many people still alive to interview about their experiences as volunteers, staff or mothers in the 1930s. Oxford was prosperous, expanding, with a stable and vocal public-spirited middle class. Merthyr Tydfil, on the other hand, suffered chronic unemployment, drastic population loss, and the erosion of middle-class philanthropy. It was a Labour dominated County borough, suspicious of the 'New Motherhood' and devoted to its own working-class wives and mothers. Geographically, Oxford and Merthyr are in marked contrast. Merthyr spreads over interlocking steep sided valleys, whereas Oxford was built on a flood plain. Tottenham is an interesting, more metropolitan area, compact, proud of being a 'leading edge' in the provision of services for mothers and children; in politics, more sedately Labour (Co-operative Labour) than Merthyr. Oxfordshire, by contrast with all these three, was the epitome of an old fashioned English county, where gentry owned whole villages and dominated county affairs, while agricultural labourers suffered poor wages and substandard housing. All four local authorities were different in the status. Merthyr Tydfil was a County Borough created at turn of the century within the County of Glamorgan from a County, cluster of villages. It operated apart from the having its own policies and its own budget. Tottenham was the inter-war an Urban District Council for most of period, without total autonomy. Some services were provided under Council Middlesex policies and budgets. Oxfordshire County had within it three urban district councils with varying like levels of independence, in addition to Oxford which, Merthyr Tydfil, was a totally independent County Borough. in the All these boroughs attracted social researchers inter-war years. Oxfordshire was chosen in a study on infant mortality to represent a rural county with particularly low infant mortality rates, published by the League of Nations in 1931 and also as an occasional paper by the Ministry of Health; Merthyr Tydfil featured in a Ministry of Health study on the causes of maternal mortality, as a borough with particularly high rates; Oxford is the centre of a study on the growth of social services in a region experiencing industrial expansion at a time of industrial crisis elsewhere; and Tottenham attracted interest as a centre of excellence in public welfare provision. (2) At the time, there was controversy about the efficacy of maternity and child welfare work. In 1938 an editorial in the Medical Officer talked of the pessimistic and optimistic views on the movement; The pessimistic view is that these improvements are the minimum that must have happened, that the rising tide of progress and prosperity dragged them up in its train, and that the child welfare movement has had little say in their achievement. The optimistic view is that these improvements in child nurture are far in advance of general progress, that they are